t2health - developmenthttp://t2health.dcoe.mil/category/blog-keywords/development
enThe Need to Evaluate Mobile Health Toolshttp://t2health.dcoe.mil/blogs/mobile-health/need-evaluate-mobile-health-tools
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Private companies, government institutions, academics and even individuals have produced thousands of mobile tools aimed at improving people’s health. With a couple of clicks on their smartphone, people can access apps that help them do everything from lose weight to manage their diabetes to have more constructive conflicts with their romantic partner.</p>
<p>
These developments are both exciting and timely. The average visit with a primary care doctor runs a meager <a href="http://khn.org/news/15-minute-doctor-visits/">15-20 minutes</a>, and the traditional model of care (i.e., sick person sees a provider face-to-face until they feel better) can’t meet the growing demand for health services. This is particularly true as the U.S. population increasingly struggles with <a href="http://www.cdc.gov/chronicdisease/overview/index.htm">chronic conditions</a> that will need a lifetime of daily management. Also, while up to 50 percent of Americans will experience a mental health condition at some point in their lives, the vast majority of those people will <a href="https://www.researchgate.net/publication/258130528_Novel_Models_for_Delivering_Mental_Health_Services_and_Reducing_the_Burdens_of_Mental_Illness">never see a behavioral health provider</a>. Mobile health (mHealth) interventions, such as mobile apps and websites, help fill these gaps in care by giving people 24-hour access to health care and health-related information. Research is showing that this can reduce the cost of care, and, most importantly, improve health outcomes.</p>
<p>
Yet, as with any new technology, we must be careful. Unlike medications or other kinds of medical devices, there’s practically no government regulation of mHealth tools. While it has long been recognized that there is a need to <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4286553/">evaluate mHealth apps</a>, research in this field is in its earliest stages. While some studies show that mHealth technologies hold significant promise in helping people manage health conditions as diverse as <a href="https://www.researchgate.net/publication/235381085_Motivational_Enhancement_System_for_Adherence_MESA_Pilot_Randomized_Trial_of_a_Brief_Computer-Delivered_Prevention_Intervention_for_Youth_Initiating_Antiretroviral_Treatment">HIV</a> and <a href="http://www.jmir.org/2008/1/e7/">depression</a>, other studies should make us take have more concerning results.</p>
<p>
For example, the Swedish government’s alcohol monopoly recently released an app intended to help university students curb binge drinking by measuring their blood alcohol level and warning when it got too high. Unfortunately, a study found that, instead of reducing problematic drinking patterns among male users, the app motivated some users to <a href="http://ascpjournal.biomedcentral.com/articles/10.1186/1940-0640-9-11">drink more frequently</a>. Other studies have found that the <ahref="http://www.jmir.org/2005/1/e11/">drop-out rate</a> for mHealth intervention studies is incredibly high. In one computerized treatment for depression, only 97 of over 19,000 enrolled participants actually completed the treatment; another mHealth study only had 12 people complete the study out over 1000 enrolled participants. These findings raise important research&mdash;as well as <ahref="http://learntelehealth.org/2012/04/ethical-issues-in-mhealth-what-is-good-enough/">ethical</a>&mdash;questions.</p>
<p>
The National Center for Telehealth & Technology (T2), part of the Defense Health Agency (DHA), has been developing free mHealth interventions for service members, veterans and their families since 2008. T2 evaluates our products to better understand how they’re used on a daily basis. To that end, we have just developed the T2 Study Enrollment Generator (T2SEG) that provides app analytics for several of our products (including Breathe2Relax, Virtual Hope Box, and T2 Mood Tracker).</p>
<p>
Usage information provides researchers with precise quantitative data, which allows them to determine whether product usage relates to user’s health outcomes. Types of data include:
<ul>
<li>Objective measure of compliance rates (i.e., how many people are using the app as intended?)</li>
<li>Potential to determine dose of intervention (i.e., are people using the app enough to make a meaningful change in their behavior?)</li></ul></p>
<p>
Researchers who are interested in using the T2SEG to study our products are encouraged to <a href="http://t2health.dcoe.mil/contact">contact us</a>. We are also always interested in building partnerships with researchers who want to develop and evaluate mHealth tools for service members.</p></div></div></div><!--
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<span class="blog-author-description"><h3>Rebecca J. Fraynt, Ph.D., is a clinical psychologist in the Mobile Health Program at the <a href="/" target="_blank">National Center for Telehealth &amp; Technology (T2).</h3>
<h5>The views expressed are those of the author and do not reflect the official policy or position of the National Center for Telehealth &amp; Technology, the Defense Centers of Excellence for Psychological Health &amp; Traumatic Brain Injury, the Department of Defense or the U.S. Government.</h5>
<p>&nbsp;</p></span><div class="field-item even"> Read other posts by <a href="/category/blog-authors/dr-rebecca-j-fraynt">Dr. Rebecca J. Fraynt</a></div> </div>
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Fri, 17 Jun 2016 18:08:16 +0000Mobile Health849 at http://t2health.dcoe.milHow do I know if an app is good to use with my patients?http://t2health.dcoe.mil/blogs/mobile-health/how-do-i-know-if-app-good-use-my-patients
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I can’t tell you how many times I’ve been asked this question. Here at T2, my job is to keep track of all the published research on apps that’s out there, and this means that I’m constantly on the lookout for randomized controlled trials, reviews, qualitative studies and other reported research related to apps.</p>
<p>
Every so often, I’ll present the current state of this research or give the highlights of the best studies I’ve found, and it never fails that someone will ask me how to know whether or not an app is good. By good, most people want to know if an app has been used with successful treatments, or contains evidence-based content. In other words, is it based on the best available, critically evaluated evidence or has it been found to be successful when used in treatment.</p>
<p>
The problem with this question is that most apps don’t contain citations (references to the study that shows the validity of an app’s content), so it’s a very difficult question to answer. While most printed materials or websites list information on what studies their content is based, with apps, because space is critical and users don’t like reading a lot of tiny text, references are often overlooked.</p>
<p>
That being said, there are quite a few apps available that are of extremely high quality and are immensely useful for that time between appointments. Here are a few tips on how to find a good one:
<ul>
<li>Search for apps developed by well-known organizations or universities.</li>
<li>Sometimes an app has an accompanying website that provides references. To find these sites, read the app marketplace description or do a Google search.</li>
<li>Glance at the app marketplace reviews. No matter how great the content of an app is, if it’s not a stable app (i.e., it crashes often), it’s not a good app.</li>
<li>Most apps listed on the app marketplaces include a section on how to contact the content developers. Send them an email asking for their content base.</li>
<li>Don’t always assume that a paid app is a better app; the bulk of evidence-based health apps are actually free. Beware of costly apps with vague marketplace descriptions.</li>
<li>Google Scholar and PubMed are always good standbys to use for app searches, if you have the time to wade through the material.</li>
</ul></p>
<p>
I understand that this answer isn’t fast or simple, and it’s not what most people want to hear. Just like any other tool that a healthcare provider uses in their practice, however, a recommendation for a “good app” shouldn’t be taken lightly.</p>
<p>
<i>All of T2’s apps are developed by subject matter experts using evidence-based content. Check out our <a href="http://t2health.dcoe.mil/category/products/mobile-app">app descriptions</a> to see if any look useful.</i></p></div></div></div><!--
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<span class="blog-author-description"><p>Jae Osenbach, Ph.D. is a research psychologist and subject matter expert with the Mobile Health Program at the <a href="/">National Center for Telehealth &amp; Technology (T2)</a>.</p>
<h5>The views expressed are those of the author and do not reflect the official policy or position of the National Center for Telehealth &amp; Technology, the Defense Centers of Excellence for Psychological Health &amp; Traumatic Brain Injury, the Department of Defense, or the U.S. Government.</h5>
<p>&nbsp;</p>
</span><div class="field-item even"> Read other posts by <a href="/category/blog-authors/dr-jae-osenbach">Dr. Jae Osenbach</a></div> </div>
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Tue, 23 Dec 2014 18:34:24 +0000Mobile Health683 at http://t2health.dcoe.milI Can Write This Blog Post in 30 Minuteshttp://t2health.dcoe.mil/blogs/mobile-health/i-can-write-blog-post-30-minutes
<div class="field field-name-field-blog-header field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><img src="http://t2health.dcoe.mil/sites/default/files/hourglass-on-blue.JPG" width="225" height="325" alt="" /></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"><p>Well 30 minutes was my initial estimate. As an iOS app developer at T2, I reserve the right to refine that estimate as I continue writing and it becomes apparent that my estimate is diverging from reality. And I think that I speak for software developers everywhere when I say that developing estimates is the highlight of my job. If we didn’t spend significant time estimating, all of our time and effort would be squandered on actually producing apps and software.</p>
<p>So, back to my estimate for this blog – I think my 30 minutes are already up. But now I have some real data to extrapolate from. The editors suggest that this blog be 400 words, and right about NOW I am writing my 125th word and it took me 41 minutes to get this far. I’ll leave the math to the reader to do on their own, but my new estimate for completing this blog is now 131.2 minutes. (Notice the technique of using unwarranted decimal precision to give the illusion of well-calculated estimates.)</p>
<p>Extrapolation of some ilk is a reliable way to arrive at a plausible estimate (and that’s a noble goal in just about any endeavor…strive for plausibility). Simply recall your effort on a similar project, multiply by a calculated, or contrived, difficulty factor and there’s your estimate. BTW, my estimate for this blog has now ballooned to 174.3 minutes.</p>
<p>Now we could continue and apply several other factors to arrive at increasingly accurate estimates. But estimation accuracy has its limits, which I attribute to a derivative of the Heisenberg uncertainty principle from physics. My interpretation of this principle states that you can’t estimate the effort required for a software project with increasing accuracy without adversely affecting the time available to complete the project. To illustrate, my effort on this blog is now up to 204.7 minutes, a significant portion of which can be attributed to the extra time spent on estimating this very effort!</p>
<p>I have many more tips I could share for the few who might have read this far (thanks Mom). But I am nearly out of my allotted word count. So if you are interested in more of my estimating tips, I encourage you to get a copy of the book I am working on. I estimate it will be available online and in bookstores in time for the holidays….in 2021.</p>
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<span class="blog-author-description"><p>Brian Doherty is a Program Manager at the <a href="/" target="_blank">National Center for Telehealth &amp; Technology (T2)&nbsp;</a>where he coordinates the efforts of a team of software developers and graphic artists.&nbsp; Brian leverages an extensive background in software development with Fortune 500 companies to develop iOS apps supporting the military community.</p>
<h5>The views expressed are those of the author and do not reflect the official policy or position of the National Center for Telehealth &amp; Technology, the Defense Centers of Excellence for Psychological Health &amp; Traumatic Brain Injury, the Department of Defense, or the U.S. Government.</h5>
<p>&nbsp;</p>
</span><div class="field-item even"> Read other posts by <a href="/category/blog-authors/mr-brian-doherty">Mr. Brian Doherty</a></div> </div>
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Thu, 22 Aug 2013 17:18:34 +0000Mobile Health576 at http://t2health.dcoe.mil